Basic Information
| Provider Information | |||||||||
| NPI: | 1255922498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | CASH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 JH OBRYAN AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND RIVERS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420459049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703628246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1860 JH OBRYAN AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND RIVERS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420459049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703628246 | ||||||||
| FaxNumber: | 2703629757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2021 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3015784 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.